It's not unusual to suffer from altitude sickness in the Andes or have tummy problems, despite Peru's wonderful culinary reputation. Peru's many climates mean that travelers will face different risks in different areas. While food-borne as well as mosquito-borne infections happen, many of these illnesses are not life-threatening. However, they can certainly ruin your trip. Besides getting the proper vaccinations, it’s important that you take insect repellent and exercise care in what you eat and drink.
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Before You Go
Since most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician four to eight weeks before departure. Ask your doctor for an International Certificate of Vaccination (otherwise known as the ‘yellow booklet’), which will list all the vaccinations you’ve received. This is mandatory for countries that require proof of yellow-fever vaccination upon entry, but it’s a good idea to carry it wherever you travel.
Bring medications in their original containers, clearly labeled. A signed, dated letter from your physician describing all medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.
Most doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance.
The World Health Organization (www.who.int/ith) offers a free download of its International Travel and Health booklet.
All travelers should have health insurance. If yours does not cover medical expenses abroad, consider supplemental insurance. Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditures.
The only required vaccine for Peru is yellow fever, and that’s only if you’re arriving from a yellow-fever-infected country in Africa or the Americas. It is strongly advised, though, for those visiting the jungle, as are malaria pills.
Diseases found in Peru include mosquito-borne infections such as malaria, Zika virus, yellow fever and dengue fever, although these are rare in temperate regions.
Required & Recommended Vaccinations
travelers who’ve never had chickenpox
2 doses one month apart
fever; mild case of chickenpox
1 dose before trip; booster 6–12 months later
soreness at injection site; headaches; body aches
long-term travelers in close contact with the local population
3 doses over 6-month period
soreness at injection site; low-grade fever
travelers born after 1956 who have had only one measles vaccination
fever; rash; joint pains; allergic reactions
travelers who may have contact with animals and may not have access to medical care
3 doses over 3–4 week period
soreness at injection site; headaches; body aches
all travelers who haven’t had a booster within 10 years
1 dose lasts 10 years
soreness at injection site
4 capsules by mouth, 1 taken every other day
abdominal pain; nausea; rash
1 dose lasts 10 years
headaches; body aches; severe reactions are rare
- antidiarrheal drugs (eg loperamide)
- acetaminophen (Tylenol) or aspirin
- anti-inflammatory drugs (eg ibuprofen)
- antihistamines (for hay fever and allergic reactions)
- antibacterial ointment (eg Bactroban; for cuts and abrasions)
- steroid cream or cortisone (for poison ivy and other allergic rashes)
- bandages, gauze, gauze rolls
- adhesive or paper tape
- scissors, safety pins, tweezers
- insect repellent containing DEET (for the skin)
- insect spray containing permethrin (for clothing, tents and bed nets)
- oral rehydration salts
- iodine tablets (for water purification)
- acetazolamide (Diamox; for altitude sickness)
Availability & Cost of Health Care
Lima has high-quality 24-hour medical clinics, and English-speaking doctors and dentists. Often embassies can give a list of providers. Rural areas may have the most basic medical services. You may have to pay in cash, regardless of whether you have travel insurance.
Life-threatening medical problems may require evacuation if you are in a remote area.
Pharmacies are known as farmacias or boticas, identified by a green or red cross. They offer most of the medications available in other countries. Usually each city has one pharmacy open all night.
Many of the following diseases are spread by mosquitoes. Take precautions to minimize your chances of being bitten. These precautions also protect against other insect-borne diseases like Baronellois (Oroya fever), Leishmaniasis and Chagas’ disease.
An intestinal infection, cholera is acquired through contaminated food or water, resulting in profuse diarrhea, which may cause life-threatening dehydration. Treatment includes oral rehydration and possibly antibiotics.
A viral infection, dengue is transmitted by mosquitoes which breed primarily in puddles and artificial water containers. It is especially common in densely populated, urban environments, including Lima and Cuzco.
Flu-like symptoms include fever, muscle aches, joint pains, headaches, nausea and vomiting, often followed by a rash. The body aches may be quite uncomfortable, but most cases resolve in a few days.
Take analgesics such as acetaminophen/paracetamol (Tylenol) and drink plenty of fluids. Severe cases may require hospitalization.
Malaria is transmitted by mosquito bites, usually between dusk and dawn. High spiking fevers may be accompanied by chills, sweats, headache, body aches, weakness, vomiting or diarrhea. Severe cases may lead to seizures, confusion, coma and death.
Taking malaria pills is strongly recommended for all areas in Peru except Lima and its vicinity, the coastal areas south of Lima, and the highland areas (including around Cuzco, Machu Picchu, Lake Titicaca and Arequipa). Most cases in Peru occur in Loreto in the country’s northeast, where transmission has reached epidemic levels.
Caused by ingestion of food or water contaminated by Salmonella typhi, fever occurs in virtually all cases. Other symptoms may include headache, malaise, muscle aches, dizziness, loss of appetite, nausea and abdominal pain. Either diarrhea or constipation may occur. Possible complications include intestinal perforation or bleeding, confusion, delirium or, rarely, coma.
The vaccine is usually given orally, but is also available as an injection. The treatment drug is usually a quinolone antibiotic such as ciprofloxacin (Cipro) or levofloxacin (Levaquin).
A life-threatening viral infection, yellow fever is transmitted by mosquitoes in forested areas. Flu-like symptoms may include fever, chills, headache, muscle aches, backache, loss of appetite, nausea and vomiting. They usually subside in a few days, but one person in six enters a second, toxic phase characterized by recurrent fever, vomiting, listlessness, jaundice, kidney failure and hemorrhage which can lead to death. There is no treatment except for supportive care.
Yellow-fever vaccination is strongly recommended for all those who visit any jungle area of Peru at altitudes less than 2300m (7546ft). Most cases occur in the departments in the central jungle. Get vaccinated at least 10 days before any potential exposure; it remains effective for about 10 years.
Zika virus is primarily transmitted by infected mosquitoes, typically active from dawn to dusk. It can be transmitted from a pregnant woman to her fetus. Human transmission can also occur through unprotected sex, and on occasion through saliva and urine. Symptoms include mild fever, headache, muscle and joint pain, nausea, vomiting and general malaise. Symptoms may present three to 12 days after being bitten.
The best prevention is to use long sleeves, repellent with 20% to 30% DEET and avoid being outdoors at dawn and dusk when mosquitos are most common. High-altitude destinations like Cuzco, Lake Titicaca and Machu Picchu are not considered a risk.
Altitude sickness may result from rapid ascents to altitudes greater than 2500m (8100ft). In Peru, this includes Cuzco, Machu Picchu and Lake Titicaca. Being physically fit offers no protection. Symptoms may include headaches, nausea, vomiting, dizziness, malaise, insomnia and loss of appetite. Severe cases may be complicated by fluid in the lungs (high-altitude pulmonary edema) or swelling of the brain (high-altitude cerebral edema). If symptoms persist for more than 24 hours, descend immediately by at least 500m and see a doctor.
The best prevention is to spend two nights or more at each rise of 1000m. Diamox may be taken starting 24 hours before ascent. A natural alternative is ginkgo.
It’s also important to avoid overexertion, eat light meals and abstain from alcohol. Altitude sickness should be taken seriously; it can be life threatening when severe.
To prevent hypothermia, dress in layers: silk, wool and synthetic thermals are all good insulators. Essentials include a hat and a waterproof outer layer. Carry food and lots of fluid. An emergency space blanket can be highly useful.
Symptoms are exhaustion, numbness (particularly toes and fingers), shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent bursts of energy.
To treat, go indoors and replace wet clothing with dry. Take hot liquids – no alcohol – and some high-calorie, easily digestible food. Do not rub victims, as rough handling may cause cardiac arrest.
The best prevention is wearing long sleeves, long pants, hats and shoes (rather than sandals). Use insect repellent with DEET. Protection usually lasts about six hours. Children aged two to 12 should use formulas with 10% DEET or less, which lasts about three hours.
Insect repellents containing certain botanical products, including eucalyptus oil and soybean oil, are effective but last only 1½ to two hours.
If sleeping outdoors or in accommodations where mosquitoes can enter, use a mosquito net with 1.5mm mesh, preferably treated with permethrin, tucking edges under the mattress.
Sunburn & Heat Exhaustion
Stay out of the midday sun, wear sunglasses and a wide-brimmed sun hat, and use sunblock with high SPF, UVA and UVB protection. Be aware that the sun is more intense at higher altitudes.
Dehydration or salt deficiency can cause heat exhaustion. Drink plenty of fluids and avoid excessive alcohol or strenuous activity when you first arrive in a hot climate. Long, continuous periods of exposure can leave you vulnerable to heatstroke.
Tap water in Peru is not safe to drink. Boiling water vigorously for one minute is the most effective means of water purification. At altitudes over 2000m (6500ft), boil for three minutes.
You can also disinfect water with iodine or water-purification pills or use a water filter or Steripen. Consult with outdoor retailers on the best option for your travel situation.
Travel to Lima is reasonably safe if you’re pregnant, but finding quality obstetric care outside the capital may be difficult. Tampons are not available in rural areas. It isn’t advisable for pregnant women to spend time at high altitudes. The yellow-fever vaccine should not be given during pregnancy.